Terence Haight Financial Assistance Program

Required fields are marked with asterisks (*)

Please review the Terence Haight Financial Program Policy for all details regarding available funding, eligibility criteria, requirements, and the grant review process. If you require a printed or emailed version of the application form, please contact Jennifer.Brockett@Gravenhurst.ca. The deadline for receipt of completed applications is December 15th at 4pm. Follow up communication regarding this application will primarily be via email.

Applicant Name/Organization Name

Contact person for organization

Please provide email address

Please provide phone number

Please provide mailing address

Please provide civic address (if different)

Requested grant amount

Total budgeted cost of the Project/Program/Initiative (enter answer or upload below.)

Please upload budget/financial plan for this project.

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Please upload prior year financial summary of revenues & expenses.

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Please upload statement or evidence of not-for-profit status.

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Please list current elected Board of Directors (enter answer or upload)

Please upload list of current elected Board of Directors or proof of public accountability

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Did you receive a grant in the past?

Yes

Please share the mandate of your organization?

Describe the specific Project/Program/Initiative for which you are requesting a grant.

What specific benefits will the project (if funded through this grant) provide to the Gravenhurst community? Please provide details on potential outcomes.

What would be the result/impact of receiving a reduced amount?

Do you receive other forms of assistance (cash or in-kind) from the Town of Gravenhurst? If “Yes” please provide a brief description of this assistance.

Please upload any additional documents here.

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DECLARATION

I hereby declare that this application accurately represents the activities of the organization and meets the eligibility criteria and requirements for consideration for a Terence Haight Financial Assistance Grant.

Application Prepared By:

Signature

Clear

Date:

Application Authorized By (Signing Officer for the Organization):

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